Increasing knowledge about genetic susceptibility to cancers will offer clinicians opportunities to individualize cancer prevention strategies based on patients' family history and other genetic information. However, in order to realize the large potential of oncology and primary care practice settings for initial identification of high-risk families, new methods that assist clinicians in collecting and interpreting a screening family cancer history are needed. The applicant and her collaborators have developed the prototype of an automated telecommunications system (the "Genetic Risk Easy Assessment Tool" or GREAT) that allows patients to record their family cancer history by telephone or internet, produces a pedigree diagram and database, and transmits this information to the clinician at the point of care. A pilot research project is underway to validate this system in comparison with pedigrees produced in face-to-face interviews by genetic counselors. The proposed K07 career development award would support three research aims: 1) refinement and expansion of the GREAT system, 2) investigation of its influence on the provision of cancer screening and preventive care in clinical practice and on referral for specialized assessment of genetic cancer risk, and 3) investigation of patients' responses to reviewing their family cancer history. To meet aim number 1, the applicant and collaborators will develop risk management algorithms that use the family genetic information from the GREAT system to guide clinical decision- making at the point of patient care. Aims number 2 and number 3 will be accomplished by two sequential clinical intervention studies that evaluate outcomes from introducing the GREAT system into clinical practice. Initially, oncologists' identification of possible hereditary cancer syndromes and their recommendations for care of cancer patients and their family members will be studied before and after introducing the GREAT system into the Cancer Center's oncology practices. Second, the provision of cancer prevention services in community primary care practices will be studied at baseline and after introducing the GREAT system to make the family cancer history, interpretation, and management information available during patient care. Patient questionnaires will assess the effects of recording and reviewing their family cancer history on patients' perceived individual and family cancer risk, their concerns raised by the process, and their readiness to take action to detect or prevent cancer. The applicant is an experienced primary care clinician and educator with recent postdoctoral training in genetics and translational oncology. The program of education, mentoring and research proposed for the K07 preventive oncology career development award will complete her career transition to an independent cancer control researcher with a focus on translation of cancer genetics into clinical practice.